Urinary Elimination (Exam 2)

Question 1

Micturition

Answer 1

-Complex process involving bladder, urinary spinchters, and CNS

-Impulses from the brain respond or ignore the urge

Question 2

Voiding

Answer 2

Bladder contraction and urethral sphincter and pelvic floor muscles

Question 3

Factors Influencing Urinary Elimination

Answer 3

-Growth and Development

-Sociocultural factors

-Psychological factors

-Personal habits

-Fluid intake

-Pathological condition

-Surgical procedures

-Diagnostic examinations

Question 4

Changes in Older Adults: Increased

Answer 4

-Bladder irritability

-Bladder contraction during bladder filling

-Risk of urinary incontinence

Question 5

Changes in older adults: Decreased

Answer 5

-Amount of nephrons

-Bladder muscle tone

-Bladder capacity

-Time between initial desire to void and urgent need to void

Question 6

Urinary Retention

Answer 6

-Inability to partially or completely empty the bladder

-Pressure, discomfort, pain

-Can be acute or chronic

Question 7

How to diagnoses Urinary Retention

Answer 7

-Diagnose with Post-Void Residual (PVR)

-Bladder scanner or straight cath

Question 8

Urinary Tract Infections

Answer 8

-Most common type is E-coli

Anywhere along urinary tract. Upper = kidneys. Lower=bladder

Question 9

Bacteriuria

Answer 9

-Bacteria in the urine

-Does not mean UTI. Can be indicator though

Question 10

UTI: Risk factors

Answer 10

-Presence of indwelling catheter

-Any instrumentation of urinary tract

-Urinary retention

-Fecal incontinence

-Poor hygiene

-Female

Question 11

Forms of Urinary Incontinence

Answer 11

Urgency-Stress-Overflow-Functional

Often multifactorial

Question 12

Urinary Incontinence: Overflow

Answer 12

-Poor bladder emptying or bladder obstruction

-Leaking and dribbling

-Urine stops and starts while peeing

-Males with BPH

Question 13

Urinary incontinence: Stress

Answer 13

-Exertion: Laughing, coughing, sneezing, jumping, changing positions

-Usually women after childbirth

Question 14

Urinary Incontinence: Urgenecy

Answer 14

-Overactive bladder

-Sudden and strong urge to urinate that is hard to delay

-Idopathic and older adults

Question 15

Urinary Incontinence: Functional

Answer 15

Just not being able to get to the bathroom

Question 16

Incontinecne Risk Factors

Answer 16

-More common in women and elderly

-Obesity

-Multiple pregnancies

-Neurological disorders

-Medications

-Confusion

-Dementia

-Immobility

-Depression

Question 17

Assessing for CVA tenderness

Answer 17

-Costovertebral Angle

-Testing for Kidney infection

Question 18

Normal Urine Output

Answer 18

> 30 mls/hr

Question 19

Concerned about output

Answer 19

-If output is <30 mls/hr for 2 hours

-If patient is awake and has gone 6 hours without voiding

Question 20

Urinary Chart

Answer 20

Screen shot

Question 21

Urine Testing

Answer 21

-Know to collect the urine

-Label appropriately per hospital protocol

-Send as soon as you receive unless it is a timed test

-Know if you need a preservative or not

Question 22

Urinalysis: Nursing Considerations

Answer 22

-Must be fresh

-Collect urine normal voiding, indwelling catheter, or urinary diversion

-Must have freshly voided urine

-Cannot take urine from catheter bag

Question 23

Culture and Sensitivity

Answer 23

-Can obtain from clean void or clean catch mid stream urine specimen

-Send to lap within 30 min

-Preliminary report should be available within 24 hours

-Use STERILE cup

Question 24

Abdominal Xray: KUB

Answer 24

-Determines size, shape, symmetry, location of structures of the urinary tract

-Common uses: (urinary calculi (kidney stone)

-No special Preparation

Question 25

Maintaining Adequate Fluid Intake

Answer 25

-2300 mls/day if renal function is ok, no heart disease and no need for fluid restriction -Helps flush solutes to limit bladder irritability

Question 26

If fluid intake needs increased:

Answer 26

-Schedule time to drink -Fluid Preferences -High fluid foods (fruits) -Stop drinking about 2 hours before bedtime to prevent nocturia

Question 27

Incontinence Care

Answer 27

-Be respectful of patient feelings -Pelvic floor muscle training -Lifestyle changes -Bladder retraining -Toileting schedule -Meticulous skin care

Question 27

Meticulous Skin Care: Do's

Answer 27

-Identify and treat -use skin risk assessment tool -Use appropriate skin barrier products -Ensure adequate hydration -Consult WOCN if needed

Question 28

Meticulous Skin Care: Don'ts

Answer 28

-Use traditional soap and water -Double padding the bed -Leave soiled pads

Question 29

Types of Urethral Cathetes

Answer 29

Single Lumen (No balloon) Indwelling catheter (Temp sensing) 3 way / 3 lumen (Bladder irrigation) Coude tip (Curved rounded) (enlarged prostate)

Question 30

Other types of Catheters: Suprapubic

Answer 30

Placed in the bladder through abdominal wall. (Sutured in place) (Used when blockage of urethra or when indwelling catheter causes irritation)

Question 31

Purewick

Answer 31

Sits in-between female patient legs and is hooked to genital suction They are not dry

Question 32

Condom Cath

Answer 32

Is what it is Decrease risk of infection Not fool proof

Question 33

Nursing Care: Catheter Care

Answer 33

-Regular Perineal care (Peri-Care) -Provide catheter care or baths per hospital protocol -Secure catheter to prevent pulling or movement -Empty drainage bags when it is 1/2 full -Do not allow the bag to touch the floor -Maintain a closed drainage system -Timely removing

Question 34

Before Catheter Insertion and While Indwelling

Answer 34

Peri-Care (Front to back) (Do not spread E-coli) Males: Uncircumcised -Can be delegated to nursing assistant or patients -CHG wipes with bath and Castile wipes Q12 prn

Question 35

Post-Catheter Removal

Answer 35

-At risk for urinary retention. -If have not voided in 6 hours then assessing and bladder to scan to see if there is retention -Greater than 400 preform in-out cathereization

Question 36

Lower UTI

Answer 36

-Dysuria -Frequent Urge -Cloudy Urine

Question 37

Upper UTI

Answer 37

-Back pain -Fever -Chills and shivering -Confusion -NVD

Question 38

Incontinence is often multifactorial